Studies Cardiovascular Disease (CVD) Essay Example for Free

Studies Cardiovascular Disease (CVD) Essay Introduction Cardiovascular disease (CVD) has long been considered a disorder which principally affects men in our society; consideration of the occurrence of heart attacks in females, for example, has been largely an afterthought. In the past few years, however, it has become increasingly obvious that this is not a problem limited to males, but that it occurs with great frequency in women. We now know that CVD is the cause of death more than any condition in women over the age of 50, including cancer (1) and in fact is responsible for more than a third of all deaths in women (2). It is estimated that 370,000 women in the United States die from heart disease each year. However, our knowledge base regarding CVD in African American (AA) women has not kept pace with the accumulation of data on white females. Thus, there is a deficit of information about this subgroup and the prevalence of CVD despite the fact that black women have more risk factors for CVD than do white women (3). The purpose of this paper is to review the subject of CVD in African American women and to focus upon four principal CVD categories: Coronary artery disease (CAD), hypertension, stroke, and congestive heart failure (CHF).The impact of gender and race on each of these entities will be examined in comparison to white women, and a determination will be made as to whether a different approach to the management of these disorders should be made based on ethnicity and sex. Coronary Artery Disease It has long been held that men have much more of a problem with CAD than women do; the belief has been that men are more susceptible to the disease, whereas women enjoy the benefits of hormonal protection. Gender differences in the occurrence of heart attacks have been noted, especially in the younger years of adult life. However, as each decade passes, the gap between prevalence rates for males and females progressively narrows to the point where there is essentially no difference by the seventh and eighth decades (4). Thus, although heart attack rates in women lag behind that for men by approximately ten years in the early years of adult life, equivalency is achieved later. Clinical features of CAD have also been shown to differ  substantially between men and women. The Framingham Study (5) demonstrated that CAD presented much more frequently as myocardial infarction in men than in women (49 vs. 29 percent), but women developed angina pectoris more frequently than men (47 vs. 26 percent). Risk factors for CAD such as dyslipidemia, hypertension, cigarette smoking, diabetes mellitus, family history, obesity, and sedentary lifestyle have about the same incidence in men and women. However, the effect that certain risk factors have is more adverse in women. For instance, the risk of developing CAD is much greater in diabetic women. Another risk factor with substantially greater impact on females is hypertriglyceridemia (6). African American women are especially affected by CAD in a negative manner. They have a higher mortality and morbidity than African American men and white women under the age of 55. In the age group 25-44, African American women have 2.5 times the coronary heart disease mortality risk of white women. The mortality rate from CAD for black women is about 69 percent higher than that for white women (7). Overall, in 1995, the CAD death rate for African American males was 133.1 per 1000 compared to 124.4 per 1000 for white males, or 7 percent higher for black males. Comparative rates for black and white women were 81.6 and 60.3 per 1000, respectively, indicating a 35 percent higher mortality rate for black women over white women. A study at West Virginia University stated that, compared to the overall national death rate from CVD in women of 401 per 100,000, the rate for black women in New York City was the highest among all major racial groups at 587 per 100,000. Rates for white and Hispanic women were 559 and 320 per 100,000, respectively. Mississippi had the h ighest black female CVD death rate in the nation at 686 per 100,000. The heart attack event rate is more than twice as high for black women than for white women in the age group 65-74 years (8), indicating that the impact of having a higher number of risk factors over time is more deleterious in black women. Despite a lower coronary artery disease prevalence in black women based on angiographic studies, mortality rates are higher in this group than in white women. This inverse relationship between angiographic evidence of CAD and CAD mortality represents what may be termed the paradox of CAD in African American women (9). Post-infarction mortality is also higher than that for black men and white men and women (10). It should be emphasized that first myocardial infarction occurs at an earlier age with an  earlier death in African American women. Certain risk factors are indeed more frequently seen in African American as compared to white women. There is a significantly higher incidence of hypertension and stroke in black women with myocardial infarct ion (11), and other risk factors which occur more frequently in this group include physical inactivity, higher mean body mass index (BMI) (12), and greater consumption of cholesterol and saturated fat (13). Cigarette smoking and obesity represent risks which have been documented to increase cardiovascular disease in black women. Smoking negates the advantage against CAD induced by estrogen in pre-menopausal women (14). Diabetes mellitus is of particular concern in black women as a risk factor; the death rate among diabetic blacks is 2.5 times higher than in diabetic whites (15), and black women have a higher prevalence of this disease. Diabetes completely eliminates the pre-menopausal protection that women have against CAD, and this would appear to be more of a problem for African American women. Access to preventive medical attention for CAD has been noted to be deficient for African American women. A classic example is the study performed by Schulman et al (16). Eight actors were used, of whom 4 were black, 4 were white, 4 were male, 4 were female, and the age range was from younger to older. All had videotaped interviews which were presented to more than 700 predominately white male primary care physicians attending a medical conference. The doctors were asked which patients they would be likely to refer for cardiac catheterization, based on a suggestive CAD profile which all of the patients possessed. Univariate analysis of the physicians’ responses revealed that both men (90.6 percent) and whites (90.6 percent) were more likely to be referred for cardiac catheterization than women (84.7 percent) and blacks (84.7 percent). A race-gender analysis also showed that black women in particular were referred for this diagnostic procedure 40 percent less often than white men. This study has been interpreted as demonstrating racial and gender bias against African American women by white male physicians regarding referral for a critical cardiovascular procedure designed to detect CAD. The use of hormone or estrogen replacement therapy (HRT or ERT) has been investigated intensively in the past several years regarding their possible reduction of CVD risk in post-menopausal women. Several clinical trials including PEPI, ERA, and HERS have been performed, producing results which do not show a clear CAD  mortality benefit derived from hormone use in post-menopausal women with CAD. There is still a possibility that they may be advantageous for primary prevention, and the ongoing Women’s Health Initiative should provide useful information when it is concluded. There is no indication that black women respond differently than white women to HRT/ERT regarding the impact on CVD risk. Hypertension Pre-menopausal women who are hypertensive have a CAD mortality risk which is ten times greater than normal (17). In the United States there are more hypertensive women than there are men with high blood pressure (18), and the prevalence of hypertension is greater among African American women than among white women. Specifically, the prevalence of hypertension in blacks twenty years of age or older is in excess of that for the population of the nation as a whole. The percentages are 35 for black males and 34.2 for black females, compared to 24.4 for white males and 19.3 for white females (19). Hypertension is the most important risk factor for stroke and is easily the most modifiable one. In addition, it is the largest contributor to CVD morbidity and mortality in blacks. Comparative death rates for hypertension per 100,000 population are 29.6 for black males (355 percent higher than for white males), and 21.7 for black females (352 percent higher than for white females). The third National Health and Nutrition Examination Survey (NHANES III) also found that blacks have a higher prevalence of severe or stage III hypertension compared to non-blacks (20). Several differences in the pathogenesis of hypertension have been documented to exist between blacks and whites (21). African Americans are characterized by low-renin hypertension accompanied by salt sensitivity, e.g., poor toleration of salt-loading, and greater volume expansion as a consequence. These characteristics tend to make blacks less responsive to drugs which impact on the renin-angiotensin-aldosterone system (RAAS) such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in the treatment of hypertension, and relatively more responsive to medications which decrease plasma volume, such as diuretics. Their salt sensitivity also renders them more susceptible to the hypertensive effects of a high-salt diet. It is estimated that over 70 percent of African Americans have low-renin h ypertension as compared to about half of whites. Although more  than 90 percent of blacks have essential, or primary, hypertension, the discovery of a high renin level in a black patient, for instance, an elderly African American female, is so unusual that it strongly suggests a secondary cause for the blood pressure elevation. Black patients also tend to be more responsive to dihydropyridine calcium-channel blockers (CCBs) and alpha-1 blockers. However, there are some mitigating factors. For instance, although ACE inhibitors and beta-blockers may not be as effective as other drugs when used as monotherapy in blacks, they do have an antihypertensive result similar to that seen in whites when these drugs are administered in combination with diuretics. In addition, many black patients who do not respond to monotherapy treatment with these drugs used in conventional doses may respond to higher doses, although there is a risk of more side-effects. ACE inhibitors are also indicated in the treatment of congestive heart failure and for the deadly combination of hypertension and diabetes, especially if proteinuria is present. Other pathophysiological characteristics which are different between hypertensive blacks and whites are altered vascular reactivity, increased sodium retention, increased potassium excretion, and decreased kallikrein excretion seen in blacks, as well as more nephrosclerosis. Decreases in vasodilatory substances in blacks such as kinins, prostaglandins, and dopamine are also seen. Black hypertensives have also been noted to have increased intracellular sodium and calcium concentration, decreased membrane sodium transport, and decreased red-cell sodium-potassium transport activity. These changes are believed to render the African American patient more prone to vascular, renal and circulatory alterations which result in elevated blood pressure. Complications of hypertension have an earlier age of onset and a later age of detection in blacks than in their white counterparts. The principal complications are CAD, stroke, left ventricular hypertrophy, end-stage renal disease, and congestive heart failure. Because of these facts, it is important to treat hypertension in blacks more aggressively, e.g., early, thoroughly, and with multiple drugs as necessary. In addition, non-pharmacological measures such as diet, attention to obesity, increased physical exercise, and avoidance of excess alcohol intake are essential components of a well-rounded therapeutic approach to the black hypertensive. Stroke Stroke is the third leading cause of death in the United States after coronary heart disease and cancer. There are about 500,000 strokes each year of which 150,000 are fatal. Stroke is also a major cause of physical impairment and the cost of acute and chronic care exceeds $30 billion a year in this country. A so-called â€Å"stroke belt† exists in the Southeastern part of the country, where almost 60 percent of the African American population resides (22). Although stroke is generally thought of as a disorder primarily affecting the elderly, it should be recognized that 28 percent of the victims are under age 65. African Americans have a stroke mortality which is twice that of whites (23). Age-adjusted stroke mortality rates are 76 percent higher among African American than among white men, and 54 percent higher among African American than white women (24). Although the rate of decline for stroke mortality has increased since the 1970s, there has been a recent slowdown in thi s decline. This has been especially true for African Americans, in whom stroke mortality is actually increasing. Since it is very difficult to treat stroke once the process is initiated, much of the focus has been on primary prevention. Hypertension is the most powerful predictor of stroke and is found to be a factor in 70 percent of cases (25). Control of hypertension therefore represents the best strategy to prevent stroke, and in fact a meta-analysis showed that when all studies of the association between treatment to lower blood pressure and stroke were reviewed, there was a 42 percent reduction in the incidence of stroke and a 45 percent reduction in fatal stroke when the diastolic blood pressure was reduced by 5-6 mmHg (26). In addition, the Systolic Hypertension in the Elderly Program (SHEP) demonstrated that a 36 percent decrease in stroke risk resulted from mean blood pressure reduction of 11/3.4 mmHg. This benefit was seen in all ages, races, and genders. These data and other information support the need for vigorous drug therapy of hypertension for the primary prevention of stroke. This is especially important for African American patients, particularly women. Congestive Heart Failure Congestive heart failure (CHF) is the only cardiovascular disease whose incidence is increasing. There are great differences between blacks and whites in the etiology of CHF. Hypertension is the principal precursor of  CHF in African Americans, whereas ischemic heart disease more commonly precedes CHF in whites. Mortality due to heart failure is about 2.5 times higher in blacks than in whites less than 65 years of age. Additionally, in 1990 the age-adjusted death rate for CHF among patients older than 65 years of age was 143.9 for black men compared with 117.8 for white men, and 113.4 for black women compared with 97.5 for white women (27). In a study of racial differences in heart failure, Afzal et al (28) prospectively analyzed 163 consecutive patients admitted to Henry Ford Hospital in Detroit, Michigan with a diagnosis of CHF. They found that compared with whites, blacks were younger in age (mean age 63.8 vs. 70.8, p=0.0003), and had a higher prevalence of hypertension (86 vs. 66 percent, p=0.0004), left ventricular hypertrophy (24 vs. 8 percent, p=0.02), ejection fraction

Distorted Perceptions in Fitzgeralds Tender is the Night Essay

Distorted Perceptions in F. Scott Fitzgerald's Tender is the Night    Any visitor to the French Riviera in the mid-1920s, the setting of F. Scott Fitzgerald's Tender is the Night, would describe Dr. Richard Diver as a charming, respected, well-mannered physician. Dick is a noble man who has dedicated his life to the health and protection of his beloved wife without thought to himself. Furthermore, he gives wonderful parties and is a reliable source of help to any friend in need. In fact, "to be included in Dick Diver's world for a while was a remarkable experience" (Fitzgerald, Tender, 27). Under this faà §ade of composure, however, lies a tormented personality. The stresses in Dick's life are numerous, as he deals with Nicole's breakdowns and other aspects of his career and social relationships. He has no one to help him through these difficulties but he still manages to rescue his friends in countless instances. He does his best to play his role as husband, father, friend, and physician, but he is clearly not comfortable with his responsibilities, and his confusion manifests itself through his obsession with youthfulness. Not only does Dr. Diver try to appear young and vital to the outside world, he also has an unhealthy obsession with much younger women in his life. This paternal attitude toward females mingled with sensual desire is a sign of Dick's hidden instability which slowly becomes more visible. Several events point to Dick's desire to appear younger and as his immature attitude about life. He has a strong need for social approval and tries to ensure his social standing by being a gracious and charming host to a myriad of friends and acquaintances. He is very concerned with each guest's opinion of him, and i... ...cceeding experiences. A major component of the disintegration of Dick Diver, therefore, is his confusion and immaturity regarding relationships with younger women, as well as his own need to seem youthful. His reputation and well-liked persona are achieved despite his childlike attitudes, but as he slowly loses his ability to conceal his true personality, he is deserted by everyone. Just as the incestuous actions of Nicole's father led to her illness and his private torment, Dick Diver's distorted perceptions of appropriate relationships lead to his own fall into obscurity. Works Cited Fitzgerald, F. Scott. Tender is the Night. New York, NY.: Simon & Schuster, Inc., 1982. Stanton, Robert. "'Daddy's Girl': Symbol and Theme in Tender is the Night." Critical Essays on Tender is the Night. Ed. Milton R. Stern. Boston, Ma.: G.K. Hall & Co., 1986. 118-124.

Types of Risk

Introduction Long ago people viewed â€Å"risk† as the inevitability of chance which occurred beyond the control of humans. In today’s world the concept of â€Å"risk† has turned into riches, as risky ventures have become the norm in the business world. â€Å"Risk† therefore applies to decisions that can have a bad or good outcome. The different types of â€Å"risk† can include financial, legal, ethical, information technology, or even human resource since it can exist everywhere and at any time in our lives.When we eat, we encounter the risk of food poisoning, to cross the road we run the risk of being hit by a passing motor car or even when we drive, we can increase the risk of an accident. If no risk is done then, no breakthrough can be expected. Whether it is in your career, financially, or in your business. Once you fail to take a risk then you will suffer the consequences of making significant gains, which means that you run the risk of a poss ible loss. What is Risk? According to Mortimer (2005 p. 5) â€Å"risk† is any uncertainty about a future event which might threaten an organization’s ability to accomplish its mission. Which means that it can be the chance of something happening that will have a negative impact on an organization. It is the possibility of suffering a loss that is loss of quality income, loss of profit, loss of success or even loss of life. It means therefore that change involves â€Å"risk†, but once the set program has been attained or has achieved total success â€Å"risk† vanishes.It is therefore of great importance that the management of risk be well managed. â€Å"Risk management† was engineered into dealing with the possibility that some future event might cause harm. It includes strategies and techniques for recognizing and confronting treats of risk and provided an environment for proactive decision making for the proactive decision making, for the purpose of: * â€Å"What can go wrong† * â€Å"What will we do† * â€Å"How will or can it be resolved†. Success in business to a certain degree requires owners or managers to take â€Å"risk†.Most successful businesses are managed by people who know when or how to push forward and when or how to hold back, when to sell and when to stand firm. According to Yusof (2007) p. 1. â€Å"Risk is an undeniable reality of doing business today, whether globally or locally. Although failure is in a way linked to â€Å"risk†, the successful business person should not fear â€Å"risk† but strives to understand it, to manage it, or even try to take advantage of it. In that way the business person would be able to calculate the risk before taking it.Unfortunately the world of business now is exposed to more risk, such as high interest rate, inflation, recession, high exchange rates, even political and cultural risk to name a few. Therefore it takes a great deal o f expertise to effectively manage risk in business. Financial Risk Financial Risk is associated with the use of debt financing by firms or companies, since the presence of debt involves legal and mandatory obligations to make specified payments at specified time period. There is a risk that the earnings of the firm may not be sufficient to meet these obligations towards the creditors.In case of the shareholders, the financial risks occur because it is not only the mandatory nature of debt obligations but also the property of ‘prior payments’ of these obligations. In short, the use of debt by the firm causes variability of return for both creditors and shareholders. Financial risk is usually measured by the debt/equity ratio of the firm: the higher the ratio, the greater the variability of the return and the higher the financial risk. Financial risk also involves liquidity risk, maturity risk, interest rate risk and inflation risk.Liquidity refers to situations wherein i t may not be possible to dispose or sell the assets or it maybe possible to sell only at great inconvenience of cost in terms of money and time. The greater the uncertainty about true elements, price concession, and transaction cost; the greater the liquidity risk. Liquidity Risk has a different connotation from the point of view of banks and financial institutions. In this context liquidity risk refers to their inability to meet the liability towards depositors when they want to withdraw their deposits.Maturity risks arise when the term of maturity of the security happens to be longer. Since foreseeing, forecasting and envisioning the environment, conditions and situations become more and more difficult as we go more and more into the future. The longer term investment involves risk, the longer the term of maturity the greater the risk. Interest Rates Risks are the variability in the returns on security due to changes in the level of the market interest rates, or it is the loss of principal of a fixed term security due to an increase in the general level of interest rates.When interest rates raise the value or market price of the security drops or vice versa. The degree of interest rate is directly related to the length of time to maturity of the security. If the term to maturity is long then the market value of the security may fluctuate widely. Inflation Risk is the risk that the real return on security may be less than the nominal return. In case of fixed income security, since payments in term foreign dollars are fixed. The value of the payments in real term declines as the level of commodity prices increases.Inflation risk is also known as purchasing power risk as there is always a chance that the purchasing power of invested money will decline, or that the real return will decline due to inflation. Legal Risk Most legal risk arise from the possibility that a counterparty is not legally permitted or able to enter into a transaction. Legal risk is the ris k that legal actions will impair the value of investment or it may be a risk from uncertainty due to legal actions or uncertainty in the applicability or interpretation of contracts, laws or regulations.This can cause a particular problem for companies who choose to transact business with other overseas businesses. Not only are they exposed to uncertainty relating to the laws of multiple jurisdictions, but they also face uncertainty as to which jurisdiction will have authority over any particular legal issue. This risk can be reduced by the company hiring experience corporate lawyers. Ethical Risk Ethical risks concern the impact that the business has on shareholders at the local, national and global levels.In some cases these risks can influence the organization’s intangible assets such as the human capital, the business reputation and its clientele. Some of the factors impinging ethical risks are: * The establishment of codes of conduct * Adherence to the code * Programme t o improve performance * Good internal communication * Clearly defined mechanisms to encourage employees to respect possible violation. As the evolution of new devices in the field of information technology there is also an increased tendency for hackers to try to infiltrate company’s network.The company can also face risk associated with theft or release of personal data such as employees’ social security numbers and bank account numbers. A part of this risk can be reduced by installing firewall software and additional access codes. Human Resource Risk Another type of risk is human resource, this is most important within the company as companies demand skilled labours to work with the job market. Companies suffer or run the risk of hiring workers who are paid as qualified and skilled workers, when they are not.Other risks would include labour fluctuation and also a rise in the labour cost, which may result in strikes and lock-outs by trade unions and negligence. Compan ies can reduce the risk by providing incentives to the workers and also offer educational grants for workers to upgrade their careers. Political Risk Finally, the political risk can be describes as the type of risk has to do with the political decision making process within the environment for business. The lack of transparency and accountability in a political system whereby decisions which impact businesses can change dramatically due to political or social instability.The immediate resignation of the Prime Minister of Jamaica- Hon. Bruce Golding is an ideal example of political risk. Safety Risk When running a small company, every move a business owner or employee makes is a source of risk. In any case where high risk is involved, it's prudent to consult a lawyer or other professional who can advise you on how to protect your business. If an owner runs a factory or other job site that requires workers to use machinery, equipment or vehicles in the course of business, workplace sa fety is a matter of utmost importance and a key source of risk.For this reason, they must follow guidelines set by Safety & Health Administration. In addition to workplace safety concerns involving physical injury, health issues also pose a risk to some businesses, particularly medical offices and hospitals. Employees must observe strict rule and regulation to protect the public and themselves from health-related threats. Conflicts between employees are also a main source of risk for small businesses that employ workers. Risks include claims of discrimination (including sex, race, age and discrimination based on disabilities) and harassment from other employees.These issues could lead to expensive lawsuits for the business. The company must comply with rules set by government agencies like the Ministry of Labour and ensure that it follows proper procedures in all instances and with any situation involving these issues. Sources of Risk For companies that serve certain types of goods to the public, like food and skincare products, product quality is a major concern and a high source of business risk. Some products have the potential of harming the consumer if the company doesn't take proper steps to meet quality standards.Negligence involving the products of these items could lead to legal issues and damage the company's reputation Bibliography Al, M. A. (2004). Hanbook of Management 3rd Edition. London : Pearson Education . Bhole, L. (2004). Financial Institutions and Markets 4th Edition. New Delhi, India : Tata McCraw Hill. Mortimer, D. , S. Mortimer (2005) Quality and Risk Management. Cambridge University Press, London, England Yusof, Y. (2007). Managing Financial Risk. United Kingdom: Author House .

Dream Interpretation Essay - 1656 Words

Dreams have been around since time began. The reason why they occur, even today, is a mystery. Debates have surrounded about whether dreams are meaningless or important. Since early history, people have recounted their dreams believing they were secret codes or messages. (Young) In Truman Capote’s novel In Cold Blood Perry, one of the killers, dreamed that he was saved by a bird that took him to a new place described as â€Å"paradise.† (Capote 93) Though the dreams made Perry feel superior, the meaning of his dream is fascinating but still a mystery. Dream interpretation has brought insight and knowledge to what a person’s subconscious can uphold. Experts have sought to explain what dreams actually contain. Although dream interpretation is†¦show more content†¦For those who don’t understand how people pop up in dreams but they have never seen them before have actually seen them in a passing and their subconscious brings them out in dreams - anoth er fascinating thing to study about dreams. Dreams are unexplainable and that’s why some are willing to find out if what they dream about means something more than what it appears. Dreams can be used to strengthen memories, like in non-REM dreams, or store them for comparison of old experiences with new like in REM dreams. Some believe that both types of dreams are beneficial to a person’s life. REM dreaming draws more emotions with more aggression and unknown characters while non-REM dreams more likely involve friendly encounters with more known, familiar characters. With all this research some question whether research tarnish dreams but researchers’ fight back saying that â€Å"peering and prodding do not take away the magic.† (Young) There are others, however, who disagree that dreams are helpful for a person’s mindset. Matt Walker from the University of California, Berkeley found â€Å"sleep acting as an emotional homeostasis† to strengthen negative emotional memories during REM sleep. Along with Matt Walker, Jan Born from the University of Là ¼beck in Germany believe dreams don’t have meaning and there is not much of a connection to everyday life that most researchers claim. Born argues that dreamsShow MoreRelatedInterpretation Of Dreams In Kalpa Sutra833 Words   |  4 PagesInterpretation of Dreams in Kalpa Sutra: Comparative Analysis with Freud’s Psychology of Dreams ---------------------------------------------------------------------------------------------------------------------Abstract The study attempts to analyze the psychology of dreams as given in ancient Jain text – Kalpa Sutra. Further this psychology and interpretation of dreams has been discussed in view of a renowned psychologist – Sigmund Freud how he understands of the psychology of dreams. The comparativeRead MoreSigmund Freud s The Interpretation Of Dreams Essay1383 Words   |  6 PagesThe Interpretation of Dreams, first published in 1899, takes into account dream interpretation and theories involving the human brain, why humans dream and what they could mean. 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